Rushed data collection of suspected early Covid-19 cases in Wuhan

Research by DRASTIC, a group of researchers working together to investigate the origins of SARS-CoV-2, starting from facts and not bending to any pressure. DRASTIC members were the first to discover the Mojiang ‘miners’ story.

Note (14 Feb 2021):
During WHO conference of the 9 Feb 2, Liang Wannian effectively confirmed that the data collection described in this article was part of the Feb 20 WHO initiative. The leak has now been fully validated.

1. The Request for Data Collection

On Wednesday the 19th Feb 2020, on behalf of the CCP’s national Investigation Team, the “Wuhan Novel Coronavirus Pneumonia Epidemic Prevention and Control Headquarters” sent a “Working Letter”, presumably to the Wuhan Authorities, to ask it to organize some Data Collection from some medical institutions (thereafter “the Data Collection”).

Through that letter, the Investigation Team is seeking to collect information:

  • For what: on (1) fever cases, (2) imaging of Covid19-like cases, (3) death cases from pneumonia of unknown cause
  • For which period: for medical visits/treatment during the period from October 1st to December 10, 2019. [No reason given for not extending before October the 1st]
  • From whom: at specified medical institutions, with variations depending on the form.
  • How: via 3 forms, to be sent back before Friday the 21st February 2020 5pm [thus only giving one day and a half at most to collect this information].

The Letter was likely addressed by the ‘Wuhan city novel coronavirus pneumonia epidemic prevention and control Headquarters’ to the Wuhan city authorities, who would relay it to the affected medical institutions.

Warning:
The logic of the letter is not clear at all when it comes to which medical institutions the different Data Collection requirements apply to. We are therefore adding some notes in the text where strong ambiguities persist.
Without guidance it would potentially take hours for the recipient (the City Authorities) to fully understand what the intention is, and a final resolution of the remaining ambiguities would most likely require a conversation between the City Authorities and the epidemic prevention and control Headquarters.

Regarding the request to Wuhan city to assist with the novel coronavirus pneumonia

Written instructions for search of early cases

Wuhan city novel coronavirus pneumonia epidemic prevention and control Headquarters:

Pursuant to:

(1) Search for fever cases in key areas
Jianghan District is requested to search for fever cases in (a) level 2 and above medical institutions having fever clinics within its jurisdictions and (b) all clinics that are within its jurisdiction and within three kilometers of the South China Seafood Market. [note: not 100% clear, but by far the most logical interpretation]
It should collect all fever cases from October 1st to December 10th, 2019, with Case name, ID number, time of consultation and contact information (see attached Form 1 for details).
At the same time, the above-mentioned medical institutions are requested to screen the chest imaging data of all fever cases within the same period of time and to provide the medical records of the the cases with the imaging characteristics of the novel coronavirus pneumonia (see Form 2 for details).

(2) City-wide search for novel coronavirus pneumonia-like imaging characteristics
All level 2 and above medical institutions in Wuhan City district are invited to conduct a retrospective review of the chest imaging data of all patients who visited between October 1 and December 10 , 2019 to identify the top 10 cases with imaging characteristics of the novel coronavirus pneumonia at the time of the disease (consultation) in each medical institution and provide information on each person’s case (for specific information see Form 2).

(3) City — wide check of pneumonia death cases
All medical institutions in Wuhan city jurisdiction are requested to screen all pneumonia death cases (with emphasis on pneumonia cases of unknown causes) from 1 October to 10 December 2019, find out cases with clinical features of the novel coronavirus pneumonia, and to provide information on each person’s disease case (see Form 3 for details).

(4) Case screening in key medical institutions
The following key medical institutions are requested to carry out the above
screening requests: Union Cancer Hospital of Huazhong University of Science and Technology, Wuhan Central Hospital Houhu District, Hubei Integrated Traditional Chinese and Western Medicine Hospital, Wuhan Red Cross Hospital, Wuhan Sixth Hospital, Tongji Hospital of Huazhong university of science and technology, Union Hospital Affiliated to Huazhong University of Science and Technology, Wuhan Jinyintan Hospital, Jianghan Xinxin Clinic.
[note: Confusing. Why such an explicit list when actually (1) (2) and (3) apply to different lists of medical institutions?]

The screening results of the above medical institutions should be submitted in one go.
[note: Possibly meaning each institution to send all its data (3 forms) in one submission. Alternative: Wuhan City to send back all data across all institutions in one go.]

Based on the screening results, the National Investigation Team will go to some organisations to carry out on-site investigation work. Please assist in arranging the work. Specific requirements will be notified separately.
[note: Confusing. May apply to medical institutions listed in (4), or may apply to all medical institutions (so really part of (5) below).]

(5) Other matters
Please collect the relevant reports from the general medical institutions and return the paper and electronic versions (Excel) to the National Investigation Team by 21 February 2020 at 17:00.

Contact person
Contact phone :

Forms:
1. Registration form for fever cases of medical institutions in Jianghan district, Wuhan city
2. Registration form for Wuhan City pneumonia cases with novel coronavirus pneumonia-like imaging features
3. Registration form for deaths from pneumonia in Wuhan city

February 19, 2020

This form is intended to summarize all medical visits for fever cases from 1st Oct 19 to the 10th Dec 19 within Jianghan District. It applies to:

  • All level-2 or higher medical institutions in the Jianghan District with attached fever clinics (as of the date the request is sent), plus any clinics within three kilometers of the South China Seafood Market (but still in the Jianghan District, so effectively simply lowering the level-2 or higher requirement for that part of the Jianghan District).
Jianghan District and 3km perimeter from Wuhan Seafood Market

The search for cases with novel coronavirus-like imaging features applicable to all medical institutions of level 1 and above in the entire Wuhan municipality.

  • For the level 2 and above medical institutions in the Jianghan district, all cases of novel coronavirus-like imaging in each medical institution are required to be reported (as specified in (1) of the Letter).
  • For the level 2 and above medical institutions not in the Jianghan District, the top 10 cases are to be reported.

Reporting of deaths from pneumonia of unknown cause applicable to all medical institutions in Wuhan City to identify cases with clinical features of the novel coronavirus pneumonia and provide information on each medical record

Confusion and lack of time: As mentioned above the Letter is not that clear at all and would require guidance for the City Authorities to interpret it correctly. Once the intention was clarified, the City Authorities would have then contacted the affected medical institutions. The whole process may have taken hours, limiting the actual time for data processing and case sorting by these medical institutions to about just one day.
On top of that the request letter itself shows signs of having been hastily written. The confusing progression between the collection requirements and their field of application reads a bit like a not yet properly ironed out mash-up of requirements. We also notice a very obvious typo on the 4th line (10⽇1⽇for 10⽉10⽇1) which is rather surprising.

Strict focus on Jianghan District for fever cases: The systematic reporting of all fever cases (Form 1) is limited to Jianghan District, and covers all medical within that district only when these are within 3km of the South China Seafood market (for the rest of the district it covers only level 2 and above institutions with fever clinics).
In effect Form 1 supposes that the outbreak started in Jianghan District. However this would have returned already potentially 10,000s of cases — a lot to process, so as a first go that restriction makes some sense.

Some Focus on Jianghan District for novel coronavirus-like pneumonia imaging symptoms: the Jianghan medical institutions that filled Form 1 must must list all novel coronavirus-like imaging cases under Form 2, but the other medical institutions that need to fill Form 2 only need to list the top 10 cases.

No focus on Jianghan District for the reporting of Death cases under Form 3. All medical institutions in the city must fill that form.

Overall, there is a focus on Jianghan District (where the South China Seafood market is), but still Form 2 and Form 3 should be able to cover important data for the whole city. Form 1 may actually deliver so many fever cases (10,000s) as to make any processing of that form results lengthy and difficult — if the data can be collected in time.

  • On the 31st December 2019, the Wuhan Municipal Health Commission (WMHC) reported a total so far of 27 cases [5] of viral pneumonia, based on search and retrospective investigations of unexplained viral pneumonia cases throughout the city, without giving any earliest onset date.
  • On the 5th January 2020, the Wuhan Municipal Health Commission (WMHC) updated that a total so far to 59 cases [6], and added that the earliest onset date was the 12 December 2019.
  • 23rd Jan 20, the PLA National University of Defence Science and Technology (国防科技大学) jointly establishes with two other universities a coronavirus big-data interdisciplinary research platform. ‘War Epidemic Resumption Big Data Platform’ (战疫复工大数据) uses massive multi-source heterogeneous big data, combined with the occurrence and development of the epidemic, to comprehensively model and analyze the population flow and transmission risk, facilitating government decision-making. [22, 24]
  • 24th Jan, in a widely quoted paper published in Lancet [8], Chinese specialists explain that they found 41 confirmed laboratory cases in patients admitted to hospitals between the 16th Dec 2019 and the 2nd Jan 2020 who were reported by the local health authority. They also report that the first onset case amongst these confirmed cases was on the 1st Dec 2019 [10]. To be clear, the study does not include patients whose specimens were not tested, or outpatients. Accordingly it recommends that ‘Further studies in outpatient, primary care, or community settings are needed to get a full picture of the spectrum of clinical severity’.
    Very importantly the study found that 14 cases (especially early ones) had no exposure to the seafood market.
    The 41 cases was actually not new information at all. It is in line with the 44 cases reported to the WHO by China on the 3rd January 2020, after the request was made on the 1st Jan 20 (WHO members have two days to answer).[46]
    The Lancet article forced a reappraisal of the South China Seafood Market zoonotic hypothesis, and further causes some scientists to suspect a much earlier breakout of October or November.
Extent of early confirmed cases disclosed in Lancet — 24th Jan.
  • 25th Jan, Dr. Daniel Lucey, an infectious disease specialist at Georgetown University, Lucey declared in an interview [14] that if the new Lancet data are accurate, the first human infections must have occurred in November 2019 — if not earlier — because there is an incubation time between infection and symptoms surfacing. If so, the virus possibly spread silently between people in Wuhan — and perhaps elsewhere — before the cluster of cases from the city’s now-infamous Huanan Seafood Wholesale Market was discovered in late December. “The virus came into that marketplace before it came out of that marketplace,” Lucey asserts.
  • 25th Jan, Kristian Andersen, an evolutionary biologist at the Scripps Research Institute, posts his analysis of 27 available genomes of 2019-nCoV on 25 January on a virology research website [15]. It suggests they had a “most recent common ancestor” — meaning a common source — as early as 1 October 2019.
  • 26th Jan, Kristian Andersen and Daniel Lucey positions are reproduced in an article in the well-read Science Magazine. [16]
  • 29th Jan, the Hubei Provincial Committee of the China Democratic League submitted a straight-through proposition “to establish a database of confirmed [and suspected] cases of new coronary pneumonia to support precise prevention and control of the epidemic” to Ying Yong, the Hubei Provincial Party Secretary, who approved it. The suggestion came from Professor Feng Dan, dean of the School of Computer Science of Huazhong University of Science and Technology and member of the Hubei Provincial People’s Government Advisory Committee [20].
  • 24th — 30th Jan, Official Spring Festival Holiday
  • Monday 17th Feb: WHO Full International Team arrives in China as part of the ‘WHO-China Joint Mission on COVID-19'. The full Join Mission Team consists of 25 experts from China, Germany, Japan, the Republic of Korea, Nigeria, the Russian Federation, Singapore, the United States of America and the World Health Organization. The team is co-led by Dr. Bruce Aylward (senior adviser to the WHO Director-General) and co-led by Dr. Liang Wannian (梁万年博士), the head of the COVID-19 response expert team of the National Health Commission of China (NHC).[1, 2, 9, 13]
  • Monday 17th Feb: a paper published in China CDC Weekly gives a lot of information about the Dec 19 cases: 104 confirmed cases, 62 clinically diagnosed and suspected cases. It is not cleared whether the paper was discussed with the WHO team at the time, but it was included in its recommended readings on the 19th Feb.
104 confirmed cases + suspected & diagnosed — Dec 19
  • 17th — 22nd Feb: WHO Joint-Mission Team stays in Beijing up to the 17th, then split between a Guangdong Team (18Feb-20Feb) and a Sichuan Team (18Feb-20Feb) before reconvening in Guangzhou. On the program are some visit of various local hospitals, wet markets, transport hubs, government bodies and even the Tencent headquarters in Shenzhen.
  • Wednesday 19th Feb: Data Collection request letter sent on behalf of National Investigation Team sent to Wuhan by Chinese government.
  • Thursday 20th or Friday 21st: Chinese government informs WHO investigation team that they will be allowed to visit Wuhan on Saturday the 22nd.
  • Friday 21st Feb, 5pm: data collected to be sent back to National Investigation Team.
  • Saturday 22nd Feb, a very unlikely team lead by conservation biologists from Yunnan publishes a remarkable paper [21], on a Chinese preprint site, that (1) systematically rejects the wet-market hypothesis based on a careful analysis of available sequences to that date, (2) tries to unravel the evolutionary links between the novel coronavirus and RaTG13, (3) complains about the sequences for early cases not being published, (4) clearly states that the breakout may have started in November, not with the official December cases.
  • Saturday 22nd Feb: ‘Select’ members of the WHO Team leave Guangzhou to visit 2 hospitals in Wuhan and have some workshops, spending effectively only one day in Wuhan. According to a New York Times investigation, the team was made of three Chinese and three international experts, and was eventually allowed in after team members agreed the mission would not be credible unless they went to Wuhan. [25]
  • 22nd- 24th Feb: The WHO Team goes back to Beijing, finalizes its reports. The 25 members parsed every word of the report for nearly three days. [25]

“They would get stuck on a word,” Dr. Fisher said about his Chinese colleagues

  • Monday 24th Feb, the WHO Team holds a press conference and presents its report. Final report available here [2].
  • 25th Feb: On the day following the end of the WHO mission, the CDC issued a gag order signed by 4 top directors of the CDC including Gao Fu. That order affects all CDC offices and stipulates that:
    - There should be no focus on writing research papers.
    - All new research projects must first be validated.
    - No data, sample, or any information on the epidemic can be shared without prior approval.
    - Existing papers submitted but not published must be immediately withdrawn and one should make sure that they comply with the regulation before resubmitting them (if then authorised to do so).
  • Thursday 27th Feb: Pr. Yu Chuanhua [17] is mentioned in the mainland press as working with his team on the processing of a database of 47,000 confirmed medical cases — most likely the official national database of novel coronavirus cases [11] which has been in place since the very beginning of February (based on reporting via the CDC information system), possibly supplemented at this stage by the results of the Data Collection. He only mentions a few possible November cases and no October cases at all, but he does mention a Sep 29 case flagged from the CT scanning (may be in Form 2) from a patient who dies (should be in Form 3).
    The interview seems to have been done on the 25th Feb (day of the CDC gag order) or on the 26th Feb. On the 27th Feb Pr. Yu Chuanhua called the journalist back to retract the two November cases he had just mentioned.
  • 3rd Mar: the State Council ‘Coronavirus Epidemic Joint Prevention and Control Mechanism Research Task Force’ issues a confidential gag order with nationwide effects stipulating that:
    - All publication work is to be taken over by the Task Force which will further ‘guide’ and coordinate the publication of scientific research.
    [‘guide’ is the standard euphemism in China for propaganda work, usually worded as ‘guiding public opinion’].
    - Publication work will be coordinated with the propaganda team of the Joint Prevention and Control Mechanism.
    - All universities, research institutions, medical institutions, enterprises and their staff cannot publish information on the epidemic without approval [effectively a full blanket gag order].
    - Approved publications must be be coordinated like a ‘game of chess’ at the national level.

Fever Clinic: A fever clinic (发热门诊) is a special clinic set up by the outpatient department of a regular hospital in accordance with superior instructions during the prevention and control of acute infectious diseases. There were 61 fever clinics in Wuhan [3] at the peak of the outbreak and they were officially announced on the 20th January 2020. Each fever clinic reports to one of 9 designated medical institutions (not the same 9 as in form 2).

Hospital classification system of China:

Hospital classification system of China [4]

2. Results: Early Medical Cases

We have only access to a few snapshots and screenshots of the filled-in forms from the available media reports (Epoch Times and NTD News), not the full forms that are in possession of the media outlets. However based on these few available forms, we can tell that:

The Wuhan Sixth Hospital, one of the nine key hospitals of the Chinese Communist Party, reported five eligible death cases , with two early cases, in the Excel version of Form 3:

Form 3 for Wuhan Sixth Hospital

These 5 include 3 early cases (pre-Dec):

  • Xu Xgan became ill on October 1 and died on November 3, the cause of death was not specified. Before his death in the Sixth Hospital, Xu Xqian had been given anti-infection treatment in Wuhan Central Hospital.
  • Li Qing X became ill on November 6 and died on December 8 due to severe pneumonia;
  • Another patient became ill on the November 18 and dies on December 5 due to severe pneumonia.

The Wuhan Hospital of Traditional Chinese Medicine (Hankou District), reported 3 deaths that meet the requirements of form 3, including to pre Dec 19:

  • Li Xzhen became ill on October 8 last year and died 4 days later (12th) due to a pneumonia
  • Zhou Xlan, became ill on October 14 last year, died on October 31, due to severe pneumonia

The Wuhan Eighth Hospital, reported one early death that meets the requirement of form 2:

  • Xu Xhua became ill on November 10 last year and died 11 days later (21st).

A total 40 cases of fever patients who met the imaging characteristics of novel coronavirus pneumonia-like cases were reported across 8 hospitals alone.

In the top 10 patients with imaging features reported by Wuhan Puren Riverside Hospital in Form 2, we find 9 pre-Dec cases:

  • Xiao Xgui, the earliest case of the 10, who became ill on September 25
  • 7 people, who all became ill either on the 1st or 2n October, curiously enough.
  • One person who became ill in November 21
Form 2 for Wuhan Puren Riverside Hospital

Wuhan Yaxin General Hospital did not report 10 patients, but only 8. Here we find 5 pre-Dec patients:

  • Wu Xyan who became ill on October 3
  • Zou Xlan (Oct 10), Li Xguo (Oct 19), Peng Xiu (Oct 24), Shi Xchen (Oct 30)
Form 2 for Wuhan Yaxin General Hospital

Wuhan Traditional Chinese Medicine Hospital and Wuhan Traditional Chinese Medicine Hospital (Huangpi District) reported only a few Dec 19 cases.

Wuhan Traditional Chinese Medicine Hospital (Huangpo District) reported 2 pre-Dec cases, Wuhan Traditional Chinese Medicine Hospital (Hankou District) 2 or 3 pre-Dec cases (not clear), Wuhan Central Hospital and and Wuhan Airborne Army Hospital both reported 1 pre-Dec cases.

We have no information on cases reported as per Form 1. These were not discussed directly in the few media reports.

3. Limitations

It is difficult to imagine that the medical institutions had time to through their admission notes or electronic records to properly fill in these forms. They had only two days at most to do so (Thursday 20th, Friday 21st). In particular the answers to Form 1 (Fever cases) would likely require much more time to collect.

It is quite possible that the Forms were quickly filled with the first few cases that answered the request, in particular for Form 2 which would require quickly going through all imaging cases over 70 days and then ranking them to come up with the most saillant 10 cases. More practically some doctors may be able to quickly remember a few conclusive cases they saw and offer these as suggestions.

We also note the oddity of Form 2 for Wuhan Puren Riverside Hospital, with a cluster of 7 out of the 10 cases with onset on the 1st or 2nd Oct 19, which could be due to such a collection artefact.

None of these forms is meant to indicate a definitive diagnostic of Covid-19.

  • Form 1 could be expected to cover many different fever pathologies, especially during a normal flu season. However a spike in the number of fever cases may be of interest in the first steps of an investigation, so collecting that information makes sense.
  • Form 2 may point much more directly to suspected Covid-19 cases, especially if filled by doctors who have since then handled many confirmed cases. CT imaging has shown its value in helping diagnostics Covid-19 in patient with fevers [12].
  • Form 3 may also point quite precisely to suspected fatal Covid-19 cases, especially if again filled by doctors remembering the most saillant cases they saw earlier based on recent confirmed Covid-19 cases.

All things considered Forms 2 and 3 are still of particular interest. But they would be more useful if there were accompanied with clear guidelines as to how to proceed to go about collecting that data, and if more time was given to do so.

Additionally it would be useful to have an idea of the normal frequencies of such cases (as captured by the 3 Forms requirements) seen in these hospitals in normal times — but still keeping in mind that the data reported there is likely very partial due to the limited time given to collect the data and fill the forms.

4. Discussion

The WHO team arrived in China on Monday the 17st Feb. At the time, Dr Tedros Adhanom Ghebreyesus, said that an international team of experts [1] on the WHO-led mission had arrived in Beijing and held their first meeting with Chinese public health officials.

“We are looking forward to seeing a tremendous partnership in strengthening our understanding of the Covid-19 epidemic” (Dr Tedros Adhanom Ghebreyesus)

The arrival of a (small) WHO international team was somehow delayed until Saturday the 22nd Feb [7], the day after that Data Collection finished. Practically the National Investigation Team sent by the Chinese government rushed to collect the data (with two days at most given to the already busy medical institutions). Eventually a (small) WHO team spent Saturday in Wuhan where it visited two hospitals in the modern part of town, but there is no record at all of the Data collected being disclosing to them.

In their final report, the WHO mission never mentions any early case or any result of the Data Collection initiative, or that initiative itself. The report actually does not show any case with onsets prior to the 8th December 2019.

Wuhan Confirmed/Diagnosed/Suspected/Asymptomatic by date of onset (test for asymptomatic)

There is one mention in the report of some testing November and December samples from Wuhan medical institutions and fever clinics for Covid-19. The tests done presumably by the Chinese authorities seem limited (20 sample per week) and are described as not having returned any positive:

The Joint Mission systematically enquired about testing for COVID-19 from routine respiratory disease surveillance systems to explore if COVID-19 is circulating more broadly and undetected in the community in China. These systems could include RT-PCR testing of COVID-19 virus in influenza-like-illness (ILI) and severe acute respiratory infection (SARI) surveillance systems, as well as testing of results among all visitors to fever clinics. In Wuhan, COVID-19 testing of ILI samples (20 per week) in November and December 2019 and in the first two weeks of January 2020 found no positive results in the 2019 samples, 1 adult positive in the first week of January, and 3 adults positive in the second week of January;

The report then recommends further investigation of early December cases, and nothing before.

Zoonotic origins
COVID-19 is a zoonotic virus. From phylogenetics analyses undertaken with available full genome sequences, bats appear to be the reservoir of COVID-19 virus, but the intermediate host(s) has not yet been identified. However, three important areas of work are already underway in China to inform our understanding of the zoonotic origin of this outbreak. These include early investigations of cases with symptom onset in Wuhan throughout December 2019, environmental sampling from the Huanan Wholesale Seafood Market and other area markets, and the collection of detailed records on the source and type of wildlife species sold at the Huanan market and the destination of those animals after the market was closed.

It was reported [11, 18] on the 27th February 20 that Pr. Yu Chuanhua (宇传华), vice president of Hubei Health Statistics and Information Society and professor of epidemiology and health statistics at Wuhan University, was working with his team on checking the full database of cases of novel coronavirus (Confirmed/Diagnosed/Suspected/Asymptomatic cases).

Source

That database seems to be the final word on all cases, sorted between Confirmed, Diagnosed, Suspected and Asymptomatic. It also seems to be the main source of data for the key Chinese papers at the time [8, 19] and seems to have been in existence since January.
Indeed we find mentions of that database prior the the Data Collection that closed on the 21st Feb. For instance as of the 11th February it had 44,672 confirmed cases in Wuhan city [19], with none before the 8th December (despite the Lancet article showing a 2nd December case):

National confirmed cases (onset and reporting dates) at the bottom — as of 11 Feb 20

Just after the closure of the Data Collection, there are suddenly some more mentions of that official database in the Chinese media, with some references to confirmed and suspected pre-Dec cases.

In particular the following interview in Health Times mention two November 19 cases (see image below). The interview was done either on 25th Feb 20 -the day of the CDC gag order - or on the following day (26th). Just before publication on the 27th, Pr Chuanhua called the journalist back and retracted these two November cases.

‘As of February 25, our entire database has about 47,000 confirmed cases. There are some data on patients with onsets before December 8 last year, but we cannot be sure of the authenticity of these data. Verify further.’ [..]

Professor Yu Chuanhua said, ‘For example, there is data on a patient who became ill on September 29. The data shows that the patient has not undergone nucleic acid testing. The clinical diagnosis (CT diagnosis) is a suspected case. The patient has died. This data has not been confirmed and there is no time to death. It may also be wrong data.’

Through the research of the database, Professor Yu Chuanhua found more and more case data before December 8. There were two cases in November, and the onset time was November 14 and November 21, 2019. Before December 8, there were five or six cases. Among them, one patient who became ill at the end of November was hospitalized on December 2 and was clinically diagnosed with pneumonia.’

The amount of data is too large. It is difficult to verify the data, distinguish between true and false, and sort and analyze, and the team is working hard.” Yu Chuanhua told reporters that many of these data are incomplete or incorrect, and some have no contact history. Need to further contact the patient or family member to verify.

Before the deadline for publication, Professor Yu Chuanhua said that the data of two patients with new coronary pneumonia in November were entered incorrectly, and other data have yet to be verified one by one. When is the earliest time of onset? Yu Chuanhua said ‘We need to verify one by one and investigate the relevant contact history before we can analyze it.’

Health Times article on the Analysis of the Wuhan novel coronavirus pneumonia patients database
Nov 14 and Nov 21 cases in actual spreadsheet

This raises some important questions about the exhaustivity and consistency of the official national database of novel coronavirus cases :

  • Why is that official database managed by Pr. Yu Chuanhua, and used in many papers such as [19], not showing the earlier cases that Pr. Yu Chuanhua himself mentions in [11] and [18], including a 2nd Dec onset case which still somehow made its way into the data used by the Lancet study [8]?
  • How can it happen that, after the 21st Feb when the results of the Data Collection were received, the official national database managed by Pr. Yu Chuanhua would still never show any of the suspected Wuhan October 19 cases that were reported, especially the 1st and 2nd Oct onset cases from the Form 2 (CT imaging) of Wuhan Puren Riverside Hospital?
  • Did Pr Chanhua quickly retract the two November cases after learning of the CDC gag order just issued on the 25th Feb 2010?

5. Questions

  • Why was the WHO visit of Wuhan delayed until after the completion of the Data Collection?
  • Was the WHO actually shown this data?
  • Was the WHO team directed to these hospitals with early cases?

If the answer to the above questions is no, then:

  • Did China actually fail in its reporting and transparency obligations to the WHO investigation team?
  • What was the real purpose of the Data Collection if it was not used to help with the WHO investigation?

If the answer to the above questions is yes, then:

  • Did the WHO cover up this information in their report?
  • How reliable is the data in the forms given the very small time given to process it?
  • How are we supposed to interpret the cluster of imaging cases with similarities to Covid-19 pathology at Wuhan Puren Riverside Hospital with admission dates of 1st and 2nd October 2019?
  • Given that the very rushed request for medical and admission data returned some candidates for early Covid-19 cases (going back to the very beginning of October or earlier), did China take the time to do a more thorough and coherent investigation? If not, why? If yes, where are the results?
  • Was the investigation eventually extended to prior to the 1st October 2019?
  • Were these early cases followed to refine the diagnostics, especially in the cases of deaths (for instance by testing any sample for antibodies)? If not, why? If yes, where are the results?
  • Were the results of the Data Collection added to that national database, even if starting first as suspected cases (especially for Form 2 and Form 3 cases) before further checks?
  • Why is Pr. Yu Chuanhua’s official national database of medical cases (containing confirmed, clinical, suspected, etc, cases) not showing up any of the possible October cases reported through the Forms 2 (which show at least 13 pre-November cases), since he does not mention any suspected October cases and only a few November ones in his interviews in the press only a few days after the closure of the Data Collection ?
  • Were the pre-December suspected cases that Pr. Yu Chuanhua mentioned in his dataset confirmed?
  • In particular was the 29th Sep CT-imaging case he mentioned confirmed?
  • What were the overall conclusions from the analysis and verification work of Pr. Yu Chuanhua’s team of Wuhan pre-December cases present in the official national database?
  • Were these conclusions eventually shared with the WHO?
  • Were the ‘‘War Epidemic Resumption Big Data platform” and its corresponding epidemic data shown to the WHO mission?
  • In particular was there a demonstration of how the big data of population movements during the Spring Festival travel season was used to establish a disease transmission model that was then used to model the spread of the epidemic from Wuhan to all regions of the country? [24]
  • Was the work of Pr. Yu Chuanhua eventually absorbed by the “War Epidemic Resumption Big Data platform”? [22]
  • Why was the “War Epidemic Resumption Big Data platform” with full data resolution never made public?
  • Why was the version of the “War Epidemic Resumption Big Data platform” with limited data resolution, available for a while at the web portal of the National University of Defence Science and Technology (https://nudtdata.com.cn), eventually taken away? [23]

6. Post Scriptum:

This story was initially written on the 6th of October. Since then a few elements have been added, which are worth mentioning:

The rushed data collection excercise described here was confirmed by Liang Wannian during the WHO conference on the 9th Feb 21, during which he mentioned it as the ‘Oct — 10th Dec data collection’

On the 5th Nov the Terms of Reference (ToRs) of the WHO mission were quietly published on the WHO website. These terms were negotiated with China and finalised on 31st July. No reason was given for the delay in making them public.

These ToRs contain a crucial new piece of information:

‘Retrospective review of cases identified a total of 124 confirmed cases with onset date in December 2019, 119 of whom were from Wuhan and 5 others from Hubei or other provinces, but all with travel links to Wuhan during the period of exposure.’

This was the first sem-official recognition of new Dec cases beyond the 41 disclosed on the 2nd Jan 2020 at the express request of the WHO (whereby WHO member countries have 48 hours to answer). These were the 41 mentioned in the Lancet paper. The very next sentence of the ToRs just say as much:

A study of 41 initially identified confirmed cases showed that 70% of the cases had a link to the Huanan market (Huang et al, 2020), but detailed
exposure factors within the market and elsewhere remain unclear.

This raises important questions:

  • Why were these 124 confirmed Dec 19 cases never mentioned before?
  • Was the ‘Retrospective review of cases’ the Rushed Data Collection discussed in this article?
  • Why was this crucial information withheld from at least the 31st July (finalisation of the ToRs) to the 5th Nov 2020 (publication)?
  • Why is the scientific community not given access to these cases and to any corresponding SARS-CoV-2 sequences — absolutely basic steps to do research into the virus phylogeny and its likely origins?
  • Given that there are so many confirmed cases with Dec onset, there must clearly be Nov cases too. Why did the ‘retrospective review’ mentioned not return any? Was it artificially limited to December?

As to the last point above, let’s note that one another essential aspect of the ToRs is in the very item of the WHO mission agenda which addresses the search for pre-December cases directly, cases that China has never made official:

Phase 1: Short term studies
a) Descriptive Epidemiological Study
1. In-depth reviews of hospital records for cases compatible with COVID-19 before December.

For more on the subject see also DR Lucey‘s excellent analysis.

As already above, the CDC Weekly paper by Zhang & al of the 17th Feb 20 gave a precise count of confirmed cases for Dec 19 in table (104) and approximate counts of clinically diagnosed and suspected cases in a graph (~30).

104 confirmed cases for Dec 19

An oft cited article in the SCMP of the 13th Mar 2020 gave some numbers from ‘government data’. That was just after the Rushed Data Collection and may well indeed be a first review of that data.

The first case of someone in China suffering from COVID-19 can be traced back to November 17, the report said quoting government data.[…]

By December 31, the number of confirmed cases rose to 266. On January 1, the numbers jumped to 381.

First this confirms an either confirmed or diagnosed case back in November.

Secondly, it shows that the number of cases to the 31st Dec was very high, at 266, even it it is possible that some of these were still tentatively diagnosed and not necessarily confirmed as the article says. (There was not that much time from the Rushed Data Collection closed on the 21st Feb to ascertain all the cases.)

The number on the 381 is also very interesting. Remember that on the 1st Jan the WHO asked China to disclose the number of cases. They replied with 48 hours as required on the 2nd Jan (maybe 3rd Jan in China) with 41 cases for dec, 44 cases to that day.

The difference between 44 and 381 is due to the addition from the later review of hospital records. That number betrays the huge scale of the misses. It means that 88% of cases were not diagnosed at the time (88% = (381–44)-381).

These 88% are an essential piece of information — they show how the disease could have circulated for weeks if not 2 months without being detected.

Additionally a leak reported by CNN on the 1st Dec confirms the gist of the article:

In the bottom left hand column of the graph marked 2019 the number of “confirmed cases” and “clinically diagnosed” cases appears to reach around 200 altogether. The documents do not elaborate further. To date, the clearest indication of how many cases were detected in 2019 is the 44 “cases of pneumonia of unknown etiology (unknown cause)” that Chinese authorities reported to the WHO for the period of the pandemic up to January 3, 2020

These ~200 are roughly consistent (i.e. of the same order) as what we can infer from the data collection leak.

Market samplings did not reveal any animal infected. Only environmental samples (surfaces, waste-waters) showed the presence of SARS-CoV-2.

This confirmed the various papers published in Jan/Feb 20 pointing to the fact that most likely someone took the virus into the market, hence invalidating the market-animal zoonosis hypothesis.

In these conditions any further disclosure of early cases would have likely pointed to a trail outside of the market.

After these important papers (such as the Lancet paper showing early cases with no leak to the wet market and and the remarkable paper published on the 22nd Feb arguing for more disclosure of early cases and that the outbreak likely started in November at least), the Chinese authorities quickly issued some research gag orders and made sure that the message got through:

A Chinese strategy was then set in place and followed consistently :

  • Do not release any new early cases, hence freezing the picture to early 2020 when the first gag order was issued. The result is that one year later after the disclosure of a total of 44 cases on the 3rd Jan 2020 following an official request by the WHO, there are still only 41 official Dec 19 confirmed cases properly realeased by China (174 if you count the Feb 2021 back-door semi-official release via the WHO), and NO official case before. This despite all the potential for retrospective testing and cases review. This is simply unbelievable.
  • Wait for retrospective sample testings to show early cases in foreign countries.
  • Then point to the US, France, Italy, Spain, etc as the likely source(s?) of the virus and paint China as a victim.

That strategy was not derailed by the World Health Assembly members voting in May 2020 for the WHO to conduct an investigation (largely at the request of Australia — which then bore the blunt of China retribution).
Indeed the Terms of Reference (ToRs) of that planned investigation (finalised on July 31st and only published on Nov 5th) essentially followed the zoonosis origin line and did not allow for independent fact checking.

If the 200 pre-Jan20 cases overall pointed to a foreign import then the best thing that China could do would be to disclose these early cases so as to settle the origin issue at its advantage once for all.

In the same way, if these 200 cases overall pointed to a market origin, it would still be in the interest of China to publish these as it would eliminate the doubt raised by the 14 of the official 41 Dec 19 cases that were not linked to the market and enable the investigation to focus purely on the zoonotic origin hypothesis.

So these 150+ undisclosed early cases most likely neither show that the outbreak started at the market nor started abroad.

Data Collection — Sources:

  • The original Letter and Forms were made available by the Epoch Times (see articles) and can be found here:
  • The accompanying Epoch Times article has snapshots of the filled forms and provides some more details based on about forms from other hospitals (not in the snapshots).

References & Notes:

Engineer, Data Scientist, Flâneur

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